When couples with children divorce, many child custody issues need to be addressed, including who will pay for the children’s health insurance and out-of-pocket medical costs. If parents cannot come to an agreement out of court, the judge will decide for them. In Pennsylvania, certain general standards are followed, which may be adjusted to the family’s particular circumstances.

Who provides health insurance coverage?

The judge will look at factors such as whether one or both parents have access to employer-sponsored health insurance, the relative benefits, costs of each, and which parent is currently providing insurance. Generally, but not always, the parent paying child support and/or having the higher income will be responsible for providing health insurance coverage. In some circumstances, the cost of providing health insurance will be split between the parents, in the amount proportionate to their incomes.

According to PA law, if neither parent is able to provide medical insurance, either because there is no employer-sponsored plan or because the plan exceeds “reasonable cost,” defined as 5% of net monthly income, the court may order that the child be covered under a PA government-sponsored plan.

Within 30 days of the court order, the parent providing coverage must submit written proof to the other parent that insurance has been obtained, including insurance cards and other necessary materials.

Who pays for copays and other out-of-pocket expenses?

Copays and other medical expenses in excess of $250.00 are allocated proportionately to the parents’ income. Medical expenses include surgical, dental, optical, and orthodontics, but not cosmetic, chiropractic, or psychiatric care unless so ordered by the court.

Since doctors and hospitals do not automatically allocate their bills to each parent, contact their billing offices and establish a contract defining what percentage of each bill should be charged to each parent. Both parents should sign the contract. This will avoid having the custodial parent receive the bill and be held responsible for paying it in full, leading to either a struggle to get reimbursement from the other parent or being hounded by bill collectors.

When does the obligation to provide healthcare insurance end?

Unless otherwise stipulated in an agreement or court order, a parent’s responsibility to provide health insurance ends when the child turns 18 or graduates from high school, whichever is later.

Whenever possible, divorcing couples should work to develop an out-of-court agreement, with the help of an experienced divorce lawyer, so that no stone is left unturned and no loophole is missed. By doing so, both parents maintain control over the situation and avoid turning over to a judge the final decisions that will so closely affect their own futures and the futures of their children. Contact us here at Karen A. Ulmer, P.C. to see how we can help you.